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Development and Preliminary Evaluation of a Conversational Agent Delivering Problem-Solving Therapy for Family Caregivers of Children With a Chronic Health Condition: Multiphase Mixed Methods Study

Background: Family caregivers of children with chronic health conditions experience substantial physical and mental health burdens, including burnout, anxiety, depression, fatigue, and sleep disturbances. Despite this need, validated digital mental health tools tailored to family caregivers remain limited. AI-powered conversational agents offer a promising approach for delivering on-demand, personalized mental health support, yet development and evaluation frameworks for this population are lacking. Objective: This paper describes the iterative development and formative evaluation of COCO (Caring of Caregivers Online), a conversational agent designed for family caregivers of children with chronic health conditions. COCO integrates problem-solving therapy (PST) and motivational interviewing (MI) within a human-in-the-loop development framework that progressed from rule-based interactions to a large language model (LLM)–powered conversational agent. Methods: COCO was developed across four phases: (1) caregiver persona and dialogue development based on PST and MI; (2) usability testing of a low-fidelity prototype with standardized patients in a single session of PST; (3) usability testing of a high-fidelity prototype with caregivers in a single session of PST (n=38); (4) integration of an LLM into COCO. The Wizard-of-Oz method was used across phases 2 and 3 to collect naturalistic dialogues and refine COCO’s conversational design. In phase 3, usability of COCO was assessed using the System Usability Scale (SUS). Caregiver emotions were measured before and after the session using 6 subscales of the PANAS-X. In phase 4, GPT-4 was integrated into COCO with few-shot learning and evaluated by research team members using the caregiver personas. Descriptive statistics were used to summarize quantitative measures. The MI principles and techniques used by COCO across the 4 phases were coded using the . Results: In phase 1, 4 gold-standard dialogues were developed using caregiver personas. In phase 2, standardized patients described COCO as validating and identified its problem-solving and on-demand support as helpful for caregivers. In phase 3, COCO-Wizard-of-Oz achieved a mean SUS score of 75.6% (SD 12.9%), reflecting acceptable usability. Participants demonstrated significant improvement in negative affect, sadness, guilt, and fatigue following PST sessions (

SPIRIT-CONSORT-ELM: element-level annotated dataset and large language model approach for assessing randomized controlled trial reporting

npj Digital Medicine, Published online: 06 October 2026; doi:10.1038/s41746-026-03318-6

SPIRIT-CONSORT-ELM: element-level annotated dataset and large language model approach for assessing randomized controlled trial reporting

Stereochemical origin of potential hysteresis in lithium metal batteries with lithium-rich cation-disordered rocksalt positive electrodes

Nature Nanotechnology, Published online: 05 October 2026; doi:10.1038/s41565-026-02301-2

Multiscale physicochemical and electrochemical characterizations demonstrate that atomic-scale structural distortion and nanoscale short-range ordering govern the thermodynamic and kinetic components of potential hysteresis in Li||DRX cells.

Mitophagy-related gene signatures predict prognosis and therapeutic response in hepatocellular carcinoma

3 October 2026 at 18:00

Biochem Biophys Res Commun. 2026 Sep 30;838:154646. doi: 10.1016/j.bbrc.2026.154646. Online ahead of print.

ABSTRACT

Mitophagy, a selective form of autophagy, has been implicated in tumor progression and therapeutic resistance; however, its prognostic significance in hepatocellular carcinoma (HCC) remains unclear. In this study, we comprehensively evaluated the role of mitophagy-related genes in HCC using multi-omics data. Gene expression profiles were obtained from the TCGA-LIHC and GSE14520 cohorts, and mitophagy-related genes were retrieved from the GeneCards database. Twenty differentially expressed mitophagy-related genes with prognostic value (pDEMGs) were identified, and consensus clustering stratified HCC patients into two clusters with significantly different survival outcomes (P = 0.001). A mitophagy enrichment score (MIES) was then calculated using single-sample gene set enrichment analysis (ssGSEA). Elevated MIES was associated with poorer overall survival (HR = 2.17, P = 0.005), metabolic activation, immune suppression, and differential drug sensitivity. Single-cell analysis of the GSE140228 dataset revealed heterogeneous MIES activity across cell populations, with relatively higher enrichment observed in proliferating T cells and dendritic cells. A six-gene prognostic signature (ACTR6, GAPDH, ATIC, ANP32E, CCT6A, and BSG) was developed using LASSO-Cox regression, which effectively stratified patients into high- and low-risk groups with distinct overall survival outcomes (1-, 3-, and 5-year AUCs: 0.780, 0.682, and 0.690, respectively). The risk score was correlated with immune infiltration patterns, mutational landscape, and chemotherapy response. qPCR validation further confirmed the upregulation of ACTR6, CCT6A, ATIC, and BSG in HCC cells. Collectively, these findings establish a mitophagy-related scoring system that reflects immune and genomic characteristics, as well as a six-gene signature with independent prognostic value, highlighting the potential clinical relevance of mitophagy in HCC.

PMID:42828884 | DOI:10.1016/j.bbrc.2026.154646

Cell-free DNA fragmentomics: from chromatin biology to clinical stratification

Epigenomics. 2026 Oct 3:1-13. doi: 10.1080/17501911.2026.2740396. Online ahead of print.

ABSTRACT

Plasma cell-free DNA (cfDNA) is fragmented nonrandomly, reflecting the chromatin architecture of its source cells and the nucleases that process it. The fragmentome can therefore provide an indirect readout of cellular regulatory state. This review examines how DNA methylation, chromatin accessibility, nucleosome positioning, protein occupancy, and nuclease activity shape cfDNA fragmentation and considers their implications for oncology. We organize fragmentomic measurements into four classes: coverage and protection, fragment size, fragment-end properties, and diversity and entropy metrics. We discuss the genomic contexts in which these features are informative, including repetitive and transposable elements, and compare platforms by sequencing requirements, feature portability, and the fragment populations captured by different library chemistries. We then review applications in cancer screening, tissue-of-origin inference, molecular subtyping, prognosis, minimal residual disease detection, and treatment response monitoring. A central challenge for clinical translation is attributing fragmentomic changes to their tissue of origin.

PMID:42829334 | DOI:10.1080/17501911.2026.2740396

BAF60A governs beta cell identity to control systemic glucose homeostasis

Diabetologia. 2026 Oct 3. doi: 10.1007/s00125-026-06884-2. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Chromatin remodelling is critical for maintaining pancreatic beta cell identity and function, yet the key regulatory mechanisms remain incompletely defined. This study aimed to investigate the role of the switch/sucrose non-fermentable (SWI/SNF) complex subunit BAF60A in preserving beta cell fate and glucose homeostasis.

METHODS: Pdx1-Cre-mediated BAF60A-knockout (BaBKO) and BAF60A-overexpressing (BaBOE) mice, together with tamoxifen-inducible adult beta cell-specific Smarcd1 knockout (BaBKOTM) and Isl1 knockout (Isl1BKOTM) mice, were generated to evaluate the role of BAF60A in vivo. Glucose homeostasis was assessed through glucose tolerance tests, insulin tolerance tests and glucose-stimulated insulin secretion (GSIS) assays. Multiomic analyses, including RNA-seq, ATAC-seq, Cleavage Under Targets and Tagmentation (CUT&Tag) and single-cell RNA-seq, were performed to characterise chromatin accessibility and transcriptional changes. BAF60A-interacting proteins were identified with biotin identification (BioID) and GST pull-down assays. Beta cell lineage tracing was used to assess changes in cell identity. In addition, BAF60A and the dedifferentiation marker ALDH1A3 were examined in pancreatic islets from individuals with and without type 2 diabetes.

RESULTS: BaBKO mice exhibited significant glucose intolerance, impaired GSIS and pronounced loss of beta cell identity, accompanied by the acquisition of non-beta endocrine features. Inducible deletion of Smarcd1 in adult beta cells similarly impaired beta cell maturation and promoted dedifferentiation, as confirmed by lineage tracing. BAF60A deficiency reduced enhancer accessibility and downregulated beta cell identity genes. Mechanistically, BAF60A physically interacts with the transcription factor islet-1 (ISL1) to regulate transcription of target genes. Adult beta cell-specific Isl1 deletion recapitulated key features of BAF60A deficiency and abolished the beneficial effect of BAF60A overexpression on insulin secretion. Conversely, BaBOE mice exhibited improved glucose tolerance and enhanced GSIS under high-fat diet conditions. Adeno-associated virus-mediated BAF60A overexpression markedly reduced beta cell dedifferentiation in BKS-db/db mice. In human type 2 diabetes islets, BAF60A expression was significantly reduced and inversely correlated with ALDH1A3.

CONCLUSIONS/INTERPRETATION: This work establishes BAF60A-ISL1-dependent chromatin remodelling as a key mechanism that preserves beta cell identity and function under metabolic stress, providing mechanistic insight into beta cell failure in type 2 diabetes.

PMID:42829354 | DOI:10.1007/s00125-026-06884-2

Pan-Cancer Landscape of the Novel Oxygen Sensor ADO and Its Potential Role in Hepatocellular Carcinoma

J Hepatocell Carcinoma. 2026 Sep 24;13:637010. doi: 10.2147/JHC.S637010. eCollection 2026.

ABSTRACT

BACKGROUND: Hypoxia is a key driver of tumor progression across cancers, yet oxygen-sensing mechanisms beyond HIFs remain underexplored. 2-Aminoethanethiol dioxygenase (ADO) has recently been identified as an oxygen sensor, but its role in malignancy is poorly defined. We conducted a pan-cancer analysis of ADO with a special focus on hepatocellular carcinoma (HCC), to assess its oncogenic significance and clinical potential.

METHODS: A multi-omics pan-cancer analysis of ADO expression and survival was performed using TCGA and GTEx, with validation in HCC across ICGC, GEO, and CNHPP proteomic cohorts. Correlations with genetic, epigenetic, immune, and pathways were evaluated. Drug sensitivity was predicted. Functional validation was conducted in HCC cells through proliferation, colony formation, Western blotting, and xenograft assays.

RESULTS: ADO was aberrantly expressed across cancers and showed cancer type-specific survival associations. Integrative analyses revealed links with tumor mutation burden, microsatellite instability, chromatin regulator methylation, RNA modification, proliferative signaling (G2M checkpoint, MYC, TGF-β), an immunosuppressive microenvironment, and negative correlations with ROS-responsive genes. In HCC, ADO was consistently overexpressed, associated with advanced stage, poor differentiation, residual disease, and unfavorable survival across independent cohorts. ADO-high HCC showed reduced predicted responsiveness to checkpoint blockade but increased sensitivity to sorafenib and fluorouracil. Experimentally, ADO overexpression activated ERK signaling, upregulated CD276 and HMGB1, and promoted HCC cell proliferation, while ADO depletion suppressed tumor growth in vitro and in vivo, reversible upon re-expression.

CONCLUSION: ADO plays oncogenic and immunomodulatory roles in HCC, and may serve as a potential prognostic biomarker and therapeutic target in liver cancer.

PMID:42812529 | PMC:PMC13620309 | DOI:10.2147/JHC.S637010

Spatial, single-nucleus and pathological profiling of the invasive front in early hepatocellular carcinoma for characterizing specific leading-edge cell niche and improving recurrence modeling

Int J Biol Sci. 2026 Sep 10;22(14):8090-8118. doi: 10.7150/ijbs.137262. eCollection 2026.

ABSTRACT

The tumor leading edge (TLE) is a critical region where tumor cells interact with the microenvironment to drive invasion and metastasis; however, its cellular architecture in early hepatocellular carcinoma (HCC) remains poorly understood. Here, we integrated single-nucleus RNA-seq (snRNA-seq), spatial transcriptomics, and computational pathology to investigate TLE in early HCC. We annotated 35 cell subpopulations and identified STMN1-high tumor cells as a key malignant subset enriched at the invasive front, interacting with Treg, plasma B, LAMP3⁺ dendritic cells and SPP1⁺ macrophages. Spatial analysis revealed three co-localized cell pairs-(SPP1⁺ macrophages co-localized with Tip-like and inflammatory endothelial cells), (LAMP3⁺ DCs co-localized with naive T cells), and (plasma B cells co-localized with cancer-associated fibroblasts)-forming a leading-edge tumor microenvironment (L-TME) niche associated with early relapse. We developed an L-TME-related machine-learning benchmark framework incorporating 71 imaging features (65 deep-learning + 6 pathological) based on the snRNA-seq, spatial transcriptomics and pathomics. The pathology model achieved robust performance (mean C-index=0.77) and successfully predicted the recurrence of early HCC (log-rank p < 0.05) in TCGA (n=147) and an independent in-house cohort (n=123). This study delineates the TLE cellular ecosystem of early HCC, defines a spatially coordinated immunosuppressive L-TME niche, and provides a clinically applicable predictive tool for postoperative recurrence. Integrating multi-omics with computational pathology deepens our understanding of early HCC metastasis and offers insights into improved prognostication and therapeutic strategies.

PMID:42807944 | PMC:PMC13618224 | DOI:10.7150/ijbs.137262

Immune-related biomarkers in liquid biopsy for cancer: emerging tools for non-invasive precision oncology

Front Cell Dev Biol. 2026 Sep 14;14:1878092. doi: 10.3389/fcell.2026.1878092. eCollection 2026.

ABSTRACT

Liquid biopsy has emerged as a powerful non-invasive tool in precision oncology, providing real-time insights into tumor evolution, host immune responses, and dynamic changes in the tumor immune microenvironment. By enabling minimally invasive sampling, it can overcome several limitations of conventional tissue biopsy. This review summarizes the major biological sources and components of liquid biopsy, including circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, and circulating immune cells, and discusses their value as dynamic indicators of interactions during cancer immunotherapy. Particular attention is given to immune-related biomarkers associated with immune checkpoints, immunosuppressive mechanisms, and immune escape, including circulating immune cell populations, and inflammatory cytokine profiles. We further examine their potential applications in predicting treatment response, monitoring immune-related adverse events, assessing minimal residual disease, and detecting acquired resistance. In addition, recent technological advances that are accelerating the clinical translation of liquid biopsy are highlighted, including multi-omics integration, microfluidic platforms. These approaches have improved the sensitivity, accuracy, and multidimensional characterization of tumor- and immune-derived biomarkers. Nevertheless, biological heterogeneity, limited assay standardization, and the lack of large-scale prospective validation studies continue to restrict widespread clinical implementation. Overall, immune-related biomarkers detected through liquid biopsy offer considerable potential for the longitudinal monitoring of the tumor immune microenvironment and may improve non-invasive cancer diagnosis, therapeutic monitoring, and personalized immunotherapy in the era of precision oncology.

PMID:42807637 | PMC:PMC13617286 | DOI:10.3389/fcell.2026.1878092

Spatial evolution of a cachexia-promoting microenvironment in pancreatic cancer

Cell. 2026 Sep 29:S0092-8674(26)01081-0. doi: 10.1016/j.cell.2026.09.012. Online ahead of print.

ABSTRACT

Cachexia is a major cause of morbidity in pancreatic cancer, but the cellular circuitry linking tumor progression to systemic wasting remains incompletely understood. Integrating single-cell RNA sequencing, Xenium spatial transcriptomics, multiplex immunohistochemistry, bulk transcriptomics, and functional studies across human non-cachexia, pre-cachexia, and cachexia samples, together with mouse models, we define a cachexia-associated microenvironmental niche composed of SEMA4A+ tumor cells, AQP9+ macrophages, and LOXL2+ cancer-associated fibroblasts. Mechanistically, SEMA4A-associated signaling promotes bone morphogenetic protein-2 (BMP2)-dependent acquisition of an AQP9-associated macrophage phenotype, and macrophage-derived CXCL8 activates LOXL2+ fibroblasts. LOXL2+ fibroblasts reciprocally enhance tumor cell FOSL1/SEMA4A signaling through exosomal N-glycosylated LOXL2. Spatial analyses demonstrate progressive enrichment of this niche with cachexia severity and association with postoperative development of cachexia in previously non-cachectic patients. These findings provide a framework linking local tumor ecosystem dynamics to cachexia progression.

PMID:42810340 | DOI:10.1016/j.cell.2026.09.012

Stopped-light-enhanced gravitational force sensing

Nature Nanotechnology, Published online: 29 September 2026; doi:10.1038/s41565-026-02298-8

A torsion-pendulum gravitational-force sensor with an optical microcavity readout leverages coupled photon–phonon effects to enhance sensitivity to the tiny gravitational pull from a millimetre-sized source mass.

Author Correction: Intermittent hypobaric pressure induces selective senescent cell death and alleviates age-related osteoporosis

Nature Biomedical Engineering, Published online: 28 September 2026; doi:10.1038/s41551-026-01815-3

Author Correction: Intermittent hypobaric pressure induces selective senescent cell death and alleviates age-related osteoporosis

Transketolase-like 1 potentiates PD-1 blockade in hepatocellular carcinoma by glycolysis to prime dendritic cell lactylation

Signal Transduct Target Ther. 2026 Sep 28;11(1):418. doi: 10.1038/s41392-026-02875-2.

ABSTRACT

Hepatocellular carcinoma (HCC) exhibits a suboptimal response to immune checkpoint blockade (ICB) therapy; to overcome this resistance, we aimed to delineate key immune resistance factors via multi-omics analysis, develop strategies to block their immunosuppressive axes, and engineer a targeted nanosystem to enhance immunotherapy efficacy against PD-1 resistance in HCC. Using transcriptomic and proteomic data from anti-PD-1-treated HCC patients, along with functional validation in murine models and mechanistic molecular and cell biology studies, we identified transketolase-like 1 (TKTL1) as a dual-nature biomarker where overexpression predicted poor baseline prognosis yet enhanced response to ICB. Mechanistically, TKTL1 diverts glucose flux into glycolysis rather than pentose phosphate pathway (PPP), recruiting USP9X to deubiquitinate and stabilize HIF-1α, which upregulates HK2 to amplify glycolytic output and lactate accumulation. This metabolic rewiring orchestrates dual immunosuppressive circuits through HIF-1α-driven CCL4 secretion recruiting PD-L1high dendritic cells (DCs), coupled with lactate-induced TRIM28K408 lactylation that stabilizes PD-L1 by blocking ubiquitin-mediated degradation. We engineered a hepatoma-membrane-coated MnO₂ nanosystem (CQLH) co-delivering a TKTL1 inhibitor and lactate oxidase, which disrupted the TKTL1-HIF-1α-HK2 axis, depleted lactate, and reprogrammed the tumor microenvironment, thereby enhanced anti-PD-1 therapy to suppress tumor growth, especially in TKTL1high tumors. These findings define a critical "TKTL1-glycolysis-lactate-DC" axis driving anti-PD-1 sensitivity in HCC, position TKTL1 as both a potential biomarker for ICB response and a tractable therapeutic target, and demonstrate that the targeted CQLH nanosystem overcomes resistance and enhances anti-PD-1 efficacy, offering a precision immunotherapeutic strategy for TKTL1high HCC.

PMID:42802226 | PMC:PMC13616917 | DOI:10.1038/s41392-026-02875-2

Inositol Metabolism Modulates Inflammatory Injury in Acute Pancreatitis via the ISYNA1-NETs Axis

J Inflamm Res. 2026 Sep 22;19:606503. doi: 10.2147/JIR.S606503. eCollection 2026.

ABSTRACT

BACKGROUND: Neutrophil extracellular traps (NETs) were key factors mediating inflammatory injury in acute pancreatitis (AP). To this end, there was an urgent need to identify precise and effective therapeutic targets that modulate NETs formation, providing new ideas for the prevention and treatment of AP pancreatitis injury.

GAP: To address this gap, we investigated the potential involvement of the myo-inositol metabolism in modulating NETs and inflammatory damage during AP.

METHODS: Multi-omics analysis identified myo-inositol metabolism as critical. We then established the in vitro NETs model using phorbol-12-myristate-13-acetate (PMA) to investigate the role and regulatory mechanism of inositol-3-phosphate synthase 1 (ISYNA1) on NETs formation. Finally, the findings were validated in the classic AP mouse model to verify the correlation between myo-inositol metabolism and AP pathogenesis.

RESULTS: Multiple omics analyses showed that the myo-inositol metabolic pathway is the most significant, and the key enzyme ISYNA1 involved in myo-inositol synthesis was significantly reduced. ISYNA1 was significantly downregulated in both the in vitro NETs model and in neutrophils infiltrating the pancreatic tissue of AP mice. Meanwhile, exogenous supplementation of ISYNA1 or myo-inositol significantly inhibited the NETs formation in vitro and inflammatory injury in AP mice. Mechanistically, downregulation of ISYNA1 led to reduced myo-inositol synthesis, thereby promoting NETs formation via modulation of the PI3K/AKT pathway.

CONCLUSION: ISYNA1 and myo-inositol metabolism were among the key links that regulated NETs formation and inflammatory injury in AP. Therefore, enhancing ISYNA1 and myo-inositol metabolism might serve as a potential intervention target for treating acute organ injury in AP.

PMID:42801157 | PMC:PMC13615823 | DOI:10.2147/JIR.S606503

Combined Transcriptomic and Histological Profiling Uncover Hepatic Regulatory Hierarchy of Triploid <em>Oncorhynchus mykiss</em> Under Interactive Salinity, Temperature and Body Weight Regimes

Biology (Basel). 2026 Sep 17;15(18):1646. doi: 10.3390/biology15181646.

ABSTRACT

Salinity, temperature and body weight dominate seawater acclimation in rainbow trout (Oncorhynchus mykiss), yet few studies simultaneously explore their main effects and potential correlative interactive patterns in hepatic responses. A 60-day L9 (33) orthogonal trial was performed on triploid rainbow trout with three gradients of body weight, temperature and salinity. Hepatic transcriptomics revealed that salinity drove global transcriptional remodeling and high salinity induced far fewer DEGs than medium salinity. WGCNA screened a salinity-positive blue module (r = 0.408, p = 0.0346), while alternative splicing confirmed extensive salinity-dependent post-transcriptional regulation. Semi-quantitative histology showed that 20 °C was associated with more pronounced salinity-caused hepatocellular vacuolation and karyopyknosis in the orthogonal test. Survival statistics indicated that salinity was the only factor with significant main effects (p < 0.05), and the 500 g-10 °C-10 ppt group obtained the highest survival. This multi-omics and histological dataset reveals a suggestive regulatory hierarchy-like pattern: salinity acts as the primary driver, temperature serves as a synergistic amplifier, and body weight plays a minor modulatory role. These findings provide a theoretical basis for developing size-specific salinity acclimation protocols in commercial triploid rainbow trout farming.

PMID:42792591 | PMC:PMC13604319 | DOI:10.3390/biology15181646

KIFC1 engages RUNX2/TGF-β signaling to promote lung cancer bone metastasis via disrupting bone homeostasis

Oncogene, Published online: 25 September 2026; doi:10.1038/s41388-026-03998-0

KIFC1 engages RUNX2/TGF-β signaling to promote lung cancer bone metastasis via disrupting bone homeostasis
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